Orbital Metastasis Research Articles

Solitary Orbital Metastasis Presenting as Extraocular Muscle Mass in Lung Cancer Patient: A Case Report

Solitary Orbital Metastasis Presenting as Extraocular Muscle Mass in Lung Cancer Patient: A Case Report

Clinical and instrumental diagnostics in patients with orbital metastasis

PurposeTo analyze the data of clinical and instrumental features of patients with metastatic lesions of the orbit.Methods26 patients (21 women and 5 men) with orbital metastasis aged from 42 to 84 years (mean – 57.3 ± 11.2) were examined and treated in our department in the period from 2009 to 2014. All patients underwent a complete clinical and instrumental examination including CT (MRI) and ultrasound. Metastatic orbital lesions were confirmed morphologically (23 patients) and cytologically (3 patients).ResultsA unilateral lesion of the orbit was found in 21 patients, bilateral – in 5 patients. 19 patients had a history of cancer before orbital symptoms appeared, in 3 patients – orbital symptoms preceded the identification of the primary tumor, in one patient – simultaneously with the primary focus (uveal melanoma with extraocular growth and metastasis to the contralateral orbit). According to CT and US data in 23 patients there were detected diffuse tissue with extraocular muscles involvement. The lesions mostly localized in the central and lower parts of the orbit (17 patients), rare – in the upper and outer (9 patients). Destructive changes in the orbital walls (by CT) revealed only in 4 patients. According to histogenesis the epithelial metastatic tumors were prevailed: breast cancer – in 13, gastric cancer – 3, kidney cancer – 2, thyroid cancer – 2, cancer of the uterus – 1; bowel leiomyosarcoma – in 1, uveal melanoma – in 1 patient. In 3 patients (11.5%) with morphologically confirmed metastatic cancer of the orbit the nature of the primary lesion was not identified.ConclusionsBreast cancer is most common in development of metastatic tumors. Medical history data, clinical and instrumental findings are informative to suggest malignancy in orbit, requiring the need for morphological verification of the diagnosis for adequate therapy.

Proptosis in a previously well five-year-old boy

Neuroblastoma metastasis. Ophthalmic findings may be the first presentation of a neuroblastoma which is the commonest paediatric tumour to metastasise to the orbit. The primary tumour is usually intraabdominal. Approximately 10–20% of children will have orbital metastases [1Ahmed S. Goel S. Khandwala M. et al.Neuroblastoma with orbital metastasis: ophthalmic presentation and role of the ophthalmologists.Eye. 2006; 20: 466-470Crossref PubMed Scopus (36) Google Scholar, 2Dubois S.G. Kalka Y. Lukens J.N. et al.Metastatic sites in stage IV and IVS neuroblastoma correlate with age, tumour biology, and survival.J Pediatr Hematol Oncol. 1999; 21: 181-189Crossref PubMed Scopus (308) Google Scholar] and up to 50% are bilateral [3Chung E.M. Murphey M.D. Specht C.S. et al.Pediatric orbit tumours and tumour like lesions: osseous lesions of the orbit.Radiographics. 2008; 28: 1193-1214Crossref PubMed Scopus (54) Google Scholar, 4Alfano J.E. Ophthalmological aspects of neuroblastomatosis: a study of 53 verified cases.Trans Am Acad Ophthalmol Otolaryngol. 1968; 72: 830-848PubMed Google Scholar, 5Altonbary Y. Mansour A.K. Sarhan M. et al.Proptosis is a pediatric dilemma.Ann Pediatr Child Health. 2015; 3: 1066Google Scholar]. Proptosis and ecchymosis (“raccoon eyes”) are the commonest ocular manifestations [[3]Chung E.M. Murphey M.D. Specht C.S. et al.Pediatric orbit tumours and tumour like lesions: osseous lesions of the orbit.Radiographics. 2008; 28: 1193-1214Crossref PubMed Scopus (54) Google Scholar]. The most common cause of proptosis in a child is orbital cellulitis [[5]Altonbary Y. Mansour A.K. Sarhan M. et al.Proptosis is a pediatric dilemma.Ann Pediatr Child Health. 2015; 3: 1066Google Scholar]. Histiocytosis, haemangioma or lymphangioma are further benign causes. Malignant aetiologies include rhabdomyosarcoma, Ewing’s sarcoma, lymphoma and metastases from a neuroblastoma, bone tumours or leukaemia [[5]Altonbary Y. Mansour A.K. Sarhan M. et al.Proptosis is a pediatric dilemma.Ann Pediatr Child Health. 2015; 3: 1066Google Scholar]. Typical CT or MRI features are an extra-conal soft tissue mass arising from the wall of the orbit [[8]Lonergan G.J. Schwab C.M. Suarex E.S. et al.Neuroblastoma, ganglioneuroblastoma, and ganglioneuroma: Radiologic-Pathologic Correlation.Radiographics. 2002; 22: 911-934Crossref PubMed Scopus (478) Google Scholar]. As in this patient, it can be locally aggressive extending into the infratemporal fossa structures or intra-cranially, with bony destruction of the roof and wall of the orbit and resultant bony spiculation [3Chung E.M. Murphey M.D. Specht C.S. et al.Pediatric orbit tumours and tumour like lesions: osseous lesions of the orbit.Radiographics. 2008; 28: 1193-1214Crossref PubMed Scopus (54) Google Scholar, 6Wells R.G. Sty J.R. Gonnering R.S. Imaging of the pediatric eye and orbit.Radiographics. 1989; 9: 1023-1044Crossref PubMed Scopus (14) Google Scholar, 7Lallemand D.P. Brasch R.C. Char D.H. et al.Orbital tumours in children: characterisation by computed tomography.Radiology. 1984; 151: 85-88Crossref PubMed Scopus (8) Google Scholar]. The mass may be unilateral or bilateral, unlike a rhabdomyosarcoma which is typically unilateral [[3]Chung E.M. Murphey M.D. Specht C.S. et al.Pediatric orbit tumours and tumour like lesions: osseous lesions of the orbit.Radiographics. 2008; 28: 1193-1214Crossref PubMed Scopus (54) Google Scholar]. Furthermore, rhabdomyosarcoma may involve anterior pre-septal orbital structures but a neuroblastoma will usually not [[3]Chung E.M. Murphey M.D. Specht C.S. et al.Pediatric orbit tumours and tumour like lesions: osseous lesions of the orbit.Radiographics. 2008; 28: 1193-1214Crossref PubMed Scopus (54) Google Scholar]. Neuroblastomas can cause dural and leptomeningeal metastases, with involvement of the skull causing diastasis of affected sutures [3Chung E.M. Murphey M.D. Specht C.S. et al.Pediatric orbit tumours and tumour like lesions: osseous lesions of the orbit.Radiographics. 2008; 28: 1193-1214Crossref PubMed Scopus (54) Google Scholar, 8Lonergan G.J. Schwab C.M. Suarex E.S. et al.Neuroblastoma, ganglioneuroblastoma, and ganglioneuroma: Radiologic-Pathologic Correlation.Radiographics. 2002; 22: 911-934Crossref PubMed Scopus (478) Google Scholar]. This child had clinical, radiological and pathological findings consistent with metastatic neuroblastoma and an MRI abdomen (Fig. 2) revealed a left adrenal primary site. Proptosis in a previously well five-year-old boyJournal of Clinical NeuroscienceVol. 34PreviewA five-year-old boy presented with a one-week history of left-sided proptosis and retro orbital pain, with no prior medical or surgical history. On examination, there was left-sided proptosis with no visual field defect or other neurological abnormality. Full blood count, electrolytes and inflammatory markers were unremarkable. Full-Text PDF

An isolated orbital mass with proptosis and diplopia: an uncommon metastasis from intracranial olfactory neuroblastoma in a chinese patient.

PurposeOlfactory neuroblastoma (ONB) is a rare neuroectodermal malignant neoplasm that originates from the olfactory sensory epithelium. In reported cases involving the orbit, the primary neoplasms could invade the orbits through bone destruction or cranio-orbital communication anatomical structure. The present study reports a rare case of orbital metastatic tumor arising from an intracranial ONB in a Chinese patient, which is the first case demonstrating an uncommon route of ONB involving the orbit.Patient and methodsA 62-year-old man with a right orbital tumor was diagnosed as having a secondary tumor arising from intracranial ONB. Clinical examination, including ocular imaging examination, and histopathological and immunohistochemical studies were performed.ResultsIn the ocular examination, a focal, firm, nontender swelling with ill-defined margins in the right orbit was found on palpation. Proptosis, limited eyeball movement, and visual loss were also observed. The unenhanced computed tomography scan showed a homogeneous, isolated, ill-defined soft tissue neoplasm in the right orbit. The histopathological study revealed irregularly shaped nests of tumor cells surrounded by avascularized fibrous stroma. The monomorphic malignant tumor cells are small round blue cells that are slightly larger than mature lymphocytes, with a very high nuclear to cytoplasmic ratio. The immunohistochemical staining for tumor cells was positive for synaptophysin, chromogranin A, cluster of differentiation 56 (CD56), cytokeratin, vimentin, S-100 protein, and negative for epithelial membrane antigen, and cluster of differentiation (CD99).ConclusionThis is so far the first Chinese case of orbital metastasis from intracranial ONB that has ever been reported. Metastasis might be another route of ONB invading the orbit besides direct invasion.

Signet ring adenocarcinoma of the colon presenting as an orbital metastasis

A 67-year-old woman was referred after MRI imaging revealed an infiltrative, diffusely enhancing left intraconal lesion. Ophthalmic examination revealed a left proptosis, resistance to globe retropulsion, and restriction of extraocular motility in all fields of gaze. The result of a biopsy via an orbitotomy was consistent with signet ring adenocarcinoma. PET scanning was significant for lytic vertebral and rib lesions and activity within the cecum. Colonoscopy confirmed the diagnosis of stage 4 colonic adenocarcinoma. Although colon carcinoma presenting as an extraconal orbital metastasis has been reported, this is the first reported case of signet ring adenocarcinoma of the colon presenting as an intraconal orbital metastasis without eyelid involvement. Orbital metastatic disease from known primary malignancies is uncommon and in particular from carcinomas arising from the gastrointestinal tract. When metastatic orbital disease is found, studies have reported that as high as 42 % of these patients have an undiagnosed primary malignancy. This allows orbital surgery to play a role detecting as yet undiagnosed carcinomas.

Orbital Metastasis of Multiple Myeloma: Case Report.

A 68-year-old woman with a history of multiple myeloma presented to the clinic with pain and vision loss in her right eye. Proptosis was observed in her right eye and eye movements were restricted in all directions. Best corrected visual acuity was 3/10 in her right eye. On biomicroscopic examination, hyperemia and subconjunctival hemorrhage were present. Fundus examination of the right eye revealed optic disc edema and choroidal folds. In magnetic resonance imaging two orbital masses were detected. Based on the patient’s history and ocular examination, we evaluated the masses as orbital metastasis of multiple myeloma. Palliative radiotherapy was recommended.

Orbital Metastases from Breast Cancer: Retrospective Analysis at an Academic Cancer Center.

Orbital metastases from breast cancer (BC) are rare, but often debilitating. BC accounts for nearly half of metastases to the orbit. Orbital metastases may be discovered years after the initial diagnosis of BC, and are rare at initial presentation. A search of the institutional data base at an academic cancer center identified BC patients who developed or presented with orbital metastases from 2000 to 2013. Baseline characteristics, treatment modalities, survival and treatment responses were collected from the electronic medical record. There were 20 patients identified with orbital metastases (0.7% of all BC cases). The median age at diagnosis of BC was 49 years; 80% had estrogen positive disease. The interval between the initial diagnosis of BC and the presentation of orbital metastases was 8.5 years (0-19 years). Orbital disease was the initial presentation of BC in two cases. Three patients developed bilateral orbital metastases and seven had accompanying brain metastases. The most common presentation was decreased vision (55%), followed by diplopia (25%). The median survival after orbital metastases was 24 months. Thirteen patients (65%) received local radiation therapy. Of those radiated, 90% reported improvement of orbital symptoms. Other treatments included intraocular bevacizumab, surgery, and systemic therapy. Orbital metastases tend to occur in estrogen receptor positive disease and are often found years after BC onset. Orbital metastases may be associated with the development of brain metastases. Radiotherapy is the preferred local therapy and had high symptom control in this cohort. Oncologists should be aware of the signs of orbital metastases and the treatment options.

Orbital Metastasis from Breast Cancer Without Significant Changes in CT Scan and MRI.

Dear Editor, Orbital metastasis infrequently occurs in breast cancer (1); however breast cancer is the most common cause of orbital metastasis (2-5), followed by lung, prostate, gastrointestinal tract, and skin (melanoma) cancers (6, 7). Definite diagnosis of an orbital lesion includes an orbital biopsy (either FNA or open biopsy). However, in patients with known metastatic cancer, CT scan or MRI of the orbits can frequently show the presence of a mass, which often involves the orbital fat or extraocular muscles (4, 5). On the other hand, these techniques may not completely reflect the metastases. Optical coherence tomography (OCT) is another method. It is a non-contact, non-invasive and high-resolution technique for imaging. There are two types of OCT, including time-domain (such as Stratus OCT3) and frequency-domain (same as Spectralis HRA+OCT). Frequency-domain is an advanced technique in imaging speed and diagnostic sensitivity (8). The Spectralis HRA+OCT produces a unique combination of retinal angiography and optical coherence tomography. Here, we report a case of orbital metastasis in a woman with previously diagnosed metastatic breast cancer presenting with visual disturbance of the right eye which was detected by optical coherence tomography. A 53-year-old woman presented with a 2-month history of diplopia and decreased vision in her right eye. Her past medical history included stage 2, hormone-receptorpositive and HER2-negative left breast carcinoma approximately 3 years prior to her presentation. She underwent modified radical mastectomy and axillary lymph node dissection. She subsequently received chemoradiation followed by hormonal therapy. Two years later, she presented with dyspepsia and abdominal pain. An abdominopelvic computed tomography (CT) scan showed ascites, peritoneal seeding, mucosal thickening, and partial obstruction in the proximal and distal part of the stomach, which was confirmed by endoscopy. In addition, ascites analysis was positive for malignancy. Chemotherapy was instituted which led to complete response. Then she traveled to England and her treatment was continued by hormone therapy. Six months later, she returned with complaints of abdominal pain, headache and unilateral visual disturbance, including diplopia and decreased visual acuity in the right eye. A repeated abdominopelvic CT scan revealed ascites and peritoneal seeding. Neurological examination failed to reveal any focal neurological deficit. Ophthalmologic examination revealed that the patient’s visual acuity was approximately no light perception (NLP) in the right eye. CT scan with and without contrast and magnetic resonance imaging (MRI) of the orbits and head were performed, which indicated no significant change (Figure 1). The type of MRI machine was Philips 1Tesla intera and the MRI technique was axial proton density (PD), axial T1W before injection of contrast, axial and sagittal T1W non fat suppress after injection of contrast media. Generally, on MRI, metastatic lesions to the orbit present hypointense to fat on T1W and hyperintense to fat on T2W, which was not observed in our case. Furthermore, nuclear scan was negative for metastasis to the globe. However OCT (Spectralis HRA+OCT) findings were most compatible with metastatic disease in vitreous and head of the optic nerve. OCT of orbital metastasis indicates a dome shaped elevation of the neurosensory retina and retinal pigment epithelium (RPE) with adjacent subretinal fluid. It could also be associated with retinal edema, intraretinal cysts, and thickening and detachment of the RPE. About 14.2% of cases have shown highly reflective points within neurosensory detachment. These points may correspond to retinal compromise by cancer cells or macrophages containing lipofuscin and melanin granules (9, 10). A combined chemotherapy treatment with paclitaxel and carboplatin for a total of 11 cycles was started. Eye

ORBITAL METASTASES OF SOLID TUMORS. DIAGNOSTIC PROBLEMS

Актуальность. Орбитальные метастазы составляют около 15% от всех злокачественных опухолей орбиты. При появлении у больных злокачественными опухолями образования в полости орбиты возникает подозрение на орбитальный метастаз. Тем не менее у онкологических больных возможно развитие неопухолевого процесса в орбите либо появление второй злокачественной опухоли по типу первично-множественного поражения.Цель – выявить отличительные признаки метастатической опухоли орбиты для проведения дифференциального диагноза с другими опухолевыми и неопухолевыми процессами в орбите и определить алгоритм действий для установления правильного диагноза и своевременного адекватного лечения заболевания орбиты.Материал и методы. Ретроспективно проанализированы истории болезни 81 пациента со злокачественными опухолями различных органов и патологическим процессом в орбите. Из них с метастазами в орбиту было 74 больных (64 женщины и 10 мужчин в возрасте 18–87 лет, медиана 45 лет); вторая злокачественная опухоль орбиты была представлена неходжкинской лимфомой у 5 пациентов (4 женщины и 1 мужчина 55–78 лет, медиана 61 год). У двоих мужчин 64 и 66 лет развился воспалительный процесс в орбите, который имитировал метастатическую опухоль. Всем больным кроме офтальмологического обследования, компьютерной томографии орбит было проведено обследование по органам для исключения рецидива первичной опухоли и метастатического поражения других органов. Результаты. Среди метастатического поражения орбиты наиболее часто встречалась очаговая форма роста одиночной опухоли с пристеночной локализацией преимущественно под верхней стенкой орбиты, с постепенным развитием безболезненного экзофтальма и нарушением подвижности глаза. Такая же клиническая картина была характерна и для неходжкинской лимфомы орбиты. Острое воспаление тканей орбиты у онкологических больных имело стертую клиническую картину и симулировало орбитальный метастаз.Заключение. Для своевременной диагностики орбитальных метастазов необходим комплексный анализ данных анамнеза, особенностей клинической картины и результатов морфологического анализа биоптата.

Bilateral Extraocular Muscle Metastases From a Gastrointestinal Carcinoid Tumor

A man in his early 70s presented with a 3-month history of decreased vision, pain, redness, and proptosis of the left eye. His medical history was significant for metastatic gastrointestinal carcinoid following small-bowel resection and chemotherapy. His visual acuity was 20/20 OD and hand motions OS with a relative afferent pupillary defect on the left. Extraocular motility was severely limited in both eyes. Orbital magnetic resonance imaging findings are displayed in the Figure. Bilateral orbital decompression was performed with biopsy of the left inferior rectus muscle, which revealed metastatic neuroendocrine carcinoma. Immunohistochemical stains, including cytokeratin AE1/AE3, chromogranin, and synaptophysin, confirmed the diagnosis. Orbital radiation was performed with rapid improvement in his proptosis. Despite this, the vision remained poor and the patient died of widespread metastatic disease. Orbital metastasis from carcinoid tumors is rare and typically occurs as a solitary lesion. Few reports exist of bilateral orbital metastases involving all the extraocular muscles.1

Orbital Metastasis as the Presenting Feature of Carcinoma Breast

Orbital Metastasis as the Presenting Feature of Carcinoma Breast

Orbital Metastasis Is Associated With Decreased Survival in Stage M Neuroblastoma.

Approximately 30% of patients with metastatic (stage M) neuroblastoma present with periorbital ecchymosis from orbital osseous disease. Though locoregional disease is staged by imaging, the prognostic significance of metastatic site in stage M disease is unknown. We hypothesize that, compared to nonorbital metastasis, orbital metastasis is associated with decreased survival in patients with stage M neuroblastoma, and that periorbital ecchymosis reflects location and extent of orbital disease. Medical records and imaging from 222 patients with stage M neuroblastoma seen at St. Jude Children's Research Hospital between January 1995 and May 2009 were reviewed. Thirty-seven patients were <18 months of age at diagnosis and 185 were ≥18 months of age. Overall survival (OS) and 5-year survival (5YS) were compared for patients with and without orbital, calvarial and nonorbital osseous metastasis, and with and without periorbital ecchymosis (log-rank test). Associations of periorbital ecchymosis with orbital metastasis location/extent were explored (Fisher's exact test, t-test). In patients ≥18 months of age, only orbital metastasis was associated with decreased 5YS (P = 0.0323) and OS (P = 0.0288). In patients <18 months of age, neither orbital, calvarial, or nonorbital bone metastasis was associated with OS or 5YS. Periorbital ecchymosis was associated with higher number of involved orbital bones (P = 0.0135), but not location or survival. In patients ≥ 18 months of age with stage M neuroblastoma, orbital metastatic disease is associated with decreased 5YS and OS. In future clinical trials, orbital disease may be useful as an imaging-based risk factor for substratification of stage M neuroblastoma.

Orbital metastases in Italy.

To describe a series of Italian patients with orbital metastasis focusing on the outcomes in relation to the different primary site of malignancy. Retrospective chart review of 93 patients with orbital metastasis collected in a tertiary referral centre in a period of 38y and review of literature. Out of 93 patients, 52 were females and 41 were males. Median age at diagnosis was 51y (range 1 to 88y). The patients have been divided into four groups on the basis of the year of diagnosis. The frequency of recorded cases had decreased significantly (P<0.05) during the last 9.5y. Primary tumor site was breast in 36 cases (39%), kidney in 10 (11%), lung in 8 (9%), skin in 6 (6%); other sites were less frequent. In 16 case (17%) the primary tumor remained unknown. The most frequent clinical findings were proptosis (73%), limited ocular motility (55%), blepharoptosis (46%) and blurred vision (43%). The diagnosis were established by history, ocular and systemic evaluation, orbital imaging studies and open biopsy or fine needle aspiration biopsy (FNAB). Treatment included surgical excision, irradiation, chemotherapy, hormone therapy, or observation. Ninety-one percent of patients died of metastasis with an overall mean survival time (OMST) after the orbital diagnosis of 13.5mo. Breast, kidney and lung are the most frequent primary sites of cancer leading to an orbital metastasis. When the primary site is unknown, gastrointestinal tract should be carefully investigated. In the last decade a decrease in the frequency of orbital metastasis has been observed. Surgery provides a local palliation. Prognosis remains poor with a OMST of 13.5mo ranging from the 3mo in the lung cancer to 24mo in the kidney tumor.

Clinical and imaging characteristics of orbital metastatic lesions among Egyptian patients.

PurposeThe aim of the study was to review the demographic, clinical, and imaging features of Egyptian patients with orbital metastases.MethodsThe study was a retrospective study of patients with orbital metastatic lesions over the last 15 years.ResultsThe study included 37 patients. Male patients represented 54.1%. The primary tumor was breast carcinoma in 21.6% of patients, with hepatocellular carcinoma (HCC) in 16.2% and cutaneous malignant melanoma in 13.5% of patients. Bronchogenic carcinoma, prostatic carcinoma, and thyroid adenocarcinoma was the primary tumor in 8.1% of cases each. The most common primary tumor in children was neuroblastoma (42.9% of pediatric patients). In 24.3% of patients, there was no history of cancer, and the orbital metastatic lesion was the first presentation of the disease. Proptosis and/or globe displacement was the presenting feature in 78.4%, followed by diplopia and limited ocular movements in 35.1%, inflammatory manifestations in 10.8%, and ptosis in 5.4%. In 54.1% the lesion involved the right orbit and in 5.4% bilateral involvement was found. Orbital imaging showed infiltrative lesion in 62.2%, mass lesion in 21.6%, isolated muscle thickening in 10.8%, and bone metastasis in 5.4%. All cases of HCC showed osteoclastic changes, and all cases of prostatic carcinoma were osteoblastic lesions.ConclusionOrbital metastasis from HCC represented a higher incidence when compared to previous studies, probably due to the increased incidence of HCC found in the Egyptian population. Orbital metastasis can display a variety of clinical and imaging features, and a high index of suspicion is required, as 24.3% showed negative history of cancer.

Orbital Compartment Syndrome as the Presenting Sign of Disseminated Intravascular Coagulation From Metastatic Prostatic Cancer to the Orbit

A 70-year-old man with castrate-resistant metastatic prostate cancer to the lumbar spine presented with sudden onset of left orbital compartment syndrome. Hematologic workup revealed disseminated intravascular coagulation with isolated left orbital hemorrhage. A canthotomy and blood product transfusions failed to control the bleeding and restore vision. Operative intervention found a new left orbital roof metastasis from primary prostatic carcinoma. Acute onset of headache or ocular pain in patients with metastatic prostate cancer warrants further workup to rule out orbital and intracranial metastases, rare but significant clinical entities that can lead to severe complications.

Choroidal Metastases from Oncocytic Thyroid Cancer

Introduction : Choroidal and/or orbital metastases secondary to thyroid carcinoma are extremely uncommon and usually occur in late stage of the disease. The main symptoms are decreased vison and/or eye pain. However, they may be asymptomatic. They are diagnosed by clinical examination, ultrasounds, ocular computed tomography (OCT), and/or MRI. Radioactive iodine fixation is strongly suggestive of thyroid metastasis, but the certainty is given by histological study. When the last one is lacking, everyone agrees diagnosis of thyroid metastasis is nearly certain in the context of metastatic diffusion as in the following case: Case Presentation : A woman aged 58, harboring an oncocytic thyroid carcinoma with numerous metastases (lung, liver, bones, and adrenals) which did not fix radioiodine, consulted for a progressive decrease in her vision. Ophthalmological examination revealed a painless palpable mass in the left orbital arch corresponding to an orbital metastasis and a reduced visual acuity of the right eye due to a choroidal tumor. B-scan ultrasonography, retinography, angiography and OCT were suggestive of bilateral choroidal metastases. As those did not fix radioiodine, the patient received six cures of tyrosine-kinase inhibitors with a poor response for all metastatic localizations. Conclusion and Discussion : although very rare, choroidal metastases from thyroid carcinoma should be sought systematically, before the end stage of the disease, in order to prevent blindness and improve quality of life, especially when they are sensitive to radio iodine and/or to target therapy, which was not the case for our patient.

Infiltrative Lobular Breast Carcinoma Presenting Initially as an Orbital Metastatic Lesion

The incidence of orbital metastases is estimated to be 1-2 per year in large centers. The commonest orbital metastasis is from breast cancer, which tends to occur late followed by lung cancer which tends to occur relatively early in addition to a proportion of metastatic lesions from unknown primary sites. The metastatic breast lesions to the orbit can be discovered as late as 20-25 years following the identification of the primary tumor. However, the orbital metastatic lesion can be the initial manifestation in a small number of patients. We are presenting a 48-year-old female patient where the diagnosis of her lobular breast carcinoma was made after her initial presentation to the ophthalmic service because of diplopia. Her clinical course, histopathological findings of her orbital lesion as well as the radiological findings are described with extensive review of the most recent literature.

Prostatic carcinoma presenting as unilateral proptosis - a rare case report

Adenocarcinoma of prostate typically involves axial skeleton and has been infrequently reported in unusual sites like orbit. It is noteworthy that upto 1989, only 28 cases of occulo-orbital metastases of prostate cancer (PC) had been reported in the literature [1] . PC is mostly known to metastasize to the bony skeleton [2] . The lack of skeletal metastasis does not exclude the possibility of visceral/ distant metastasis, and serum PSA levels usually do not correlate with the extent of metastatic disease [3] . Here in, we report a rare case of unilateral orbital metastasis from PC.

Uterine Leiomyosarcoma Presenting With Bilateral Orbital and Left Neck Metastases

Uterine leiomyosarcoma is a rare neoplasm of mesodermic origin with a predilection for hematologic dissemination, but bilateral orbital metastases have never been reported. A 63-year-old lady presented with an 18-month history of a left neck and left breast mass, and a short history of left eye pain and intermittent diplopia. Ultrasound-guided core biopsy of the left neck node showed evidence of leiomyosarcoma, and computed tomography of the orbits demonstrated bilateral infraorbital masses arising from the medial recti. The patient was diagnosed with uterine leiomyosarcoma with orbital metastases. She was treated with bilateral orbital radiotherapy but had further disease progression, and has since started doxorubicin. Surgery is usually advocated in the management of metastatic leiomyosarcoma, but given the extensive metastases in this case, radiotherapy was the preferred option. This is the first reported case of bilateral orbital and neck metastases from a uterine leimyosarcoma. J Med Cases. 2015;6(3):131-133 doi: http://dx.doi.org/10.14740/jmc2071w

Les carcinomes épidermoïdes des paupières. Bilan de 7 ans d’expérience au service d’ophtalmologie adulte du CHU de Casablanca

Malignant eyelid tumors generate considerable functional and aesthetic complications. Squamous cell carcinoma or squamous cell epithelioma (SCE) of the eyelids represents about 9% of all peri-ocular skin tumors. It is potentially lethal by orbital invasion or metastasis and characterized by clinical polymorphism and its ability to mimic other benign lesions of the eyelids, thus requiring early diagnosis and management. The goal of our work is to establish the epidemiological and clinical characteristics, treatment modalities and prognosis of SCE of the eyelids. This retrospective study was performed over a period of 7 years on 25 cases of SCE of the eyelids. The mean age was 62 years. The gender ratio was 1.77 with a male predominance. Twelve patients had precancerous lesions. Biopsy revealed squamous epithelioma SCE in 24 cases and a mixed carcinoma in one case. Surgical treatment was performed in 23 cases. Eyelid reconstruction was immediate in all cases. Radiation therapy (RTH) was carried out for additional 5 patients. The mean follow-up was 15 months. We noted 2 cases of recurrence; revision surgery was necessary in one case and radiotherapy in the other case. SCE is often diagnosed at advanced stages in our context because of the limited access to health care and the extreme clinic polymorphism. This explains the need for histological examination of any suspicious lesion. Prevention through photoprotection is essential.